GP shortages, outdated IT equipment, inadequate premises and a funding crisis. All familiar headlines for the NHS, underpinned by a rapidly increasing workload for most GP practices. Undoubtedly, there are significant challenges ahead. But behind the headlines, pioneering work is already going on as practices look to technology to help futureproof the NHS and ensure the service can survive in the long term. So where are the quick wins for practices looking to improve quality and efficiency – and how can they be adopted during a period of change?
Following the publication of the Five Year Forward View, the direction of travel for primary care has become clearer – integrated partnership working across localities and organisations is the way forward. The opportunities this brings are significant in terms of expanding the range of services offered to patients, reducing pressure on acute services and finding more cost effective and efficient ways of working.
But change doesn’t happen overnight and the more ambitious the plans, the more challenging and time consuming they are to deliver. So how do practices tackle today’s pressures while working on tomorrow’s solutions? The smart answer is simply one step at a time – focusing on the immediate priorities and what can realistically be achieved in the short term.
What challenges do you need to fix now? Are you struggling with admin resource? Are your referrals taking too long to process? How can you ensure notes and referrals are accurately recorded and processed by your out of hours service? How can you work with your neighbouring practices when the systems you use are different? These are all questions which we have seen practices tackle in innovative ways that deliver immediate improvements without creating barriers to future federated working.
Many practices are in different stages when it comes to working with others and there are a number of different models of care being established. As these new arrangements develop in the background, there are solutions available now to help practices manage a growing and complex workload, which will be sufficiently flexible as needs change.
Technology – and in particular, cloud-based software – has come on significantly. Although the NHS has been slower to adopt the technology than other industries, cloud-based systems – ie software based on remote servers rather than managed in-house – are not new.
Increasingly, leading clinical system providers such as EMIS and SystmOne are providing cloud-based electronic patient records which is a vital step in enabling shared working across primary, secondary and community care settings. Likewise, our own cloud-based digital dictation solution – Lexacom Connect – is enabling practices to share administrative resources and process referral letters more quickly and accurately. Lexacom integrates fully with different clinical systems so organisations wanting to share admin resources can still do so, even if their patient record systems differ.
As a result, practices are starting to use technology to improve patient care and reduce costs not only within their own organisation but across localities as well. For example, Norwich-based Magdalen Medical Practice has been able to provide emergency secretarial support to a neighbouring practice, thanks to both using the same cloud-based digital dictation software. This ensured a high level of service continued despite staff shortages, and patients were not affected. Garry Mahn, Practice Manager at Magdalen Medical Practice said: “We have witnessed first-hand the advantages of sharing admin resources across practices to manage workload peaks and unexpected staff shortages.”
Southernhay House Surgery in Exeter has combined new technology with a review in the structure of its team, resulting in a time saving of approximately 20 hours per week. The practice has created new ‘administrator’ roles, combining secretarial and reception duties, alongside the introduction of our cloud-based digital dictation and speech recognition software. The practice believes this has been instrumental in improving its efficiency and freeing up staff time. According to Cindy Flatt, Practice Manager, “It is rare that a referral isn’t typed, checked and sent within 24 hours.” Southernhay’s next step is to use this cloud technology to share secretarial resources with other practices to support federated working and reduce the impact of staff shortages.
Being open minded about using cloud systems is one of the best ways to future-proof your systems. Instead of relying on managing everything on your own servers, cloud technology gives you the freedom to share information with your partners and give the flexibility to work from different locations, in accordance with information governance procedures. While cyber-security scares can put people off, the reality is that use of cloud services in themselves are no more vulnerable to a breach than other forms of IT. Using a dedicated cloud facility where the latest updates are continuously implemented, are tried and tested and where multiple layers of encryption are applied, means your data is often safer.
Reputable cloud-based systems can provide:
- Flexibility – work from different locations, including branch surgeries and clinics
- Adaptability – can be configured to work with partner organisations within, for example, a federation, cluster or CCG locality
- Security – data is stored securely, with robust back-ups in place
- Affordability – in many cases, cloud systems avoid the need for costly upfront purchases such as local servers etc
Funding new technology
Funding for new technology can be seen as a barrier. However, with money available through the Estates and Transformation Fund, some CCGs have been successful in applying for funding to improve back office systems. This is where working in partnership with neighbouring practices and enlisting the support of your CCG can make a real difference.
As well as opening up funding sources, delivering improvements in back office systems across a locality can provide the foundation for more integrated, consistent and efficient working in the future.
As new ways of working emerge, needs change and this is where practices have an opportunity to shape the systems which will support them in the future. Increasingly, the NHS is moving beyond the days of buying off the shelf solutions and is finding more innovative ways to develop services which are tailored to their particular needs. There’s no reason why this more collaborative approach can’t work for practices too.
By establishing open dialogue with potential suppliers and discussing the challenges that need to be addressed, technology companies are more able to come forward with tailored solutions. This is particularly true when it comes to having an eye on the future. It’s important to build in flexibility when it comes to new technology, so that the systems are designed to adapt and grow as traditional ways of working develop and change.
Freeing up time to focus on the future while juggling existing pressures inevitably means practices need to continuously find ways to work smarter. As federated and partnership working develops, new solutions need to be sustainable and affordable, as well as deliverable now. Far from being put off, we’re increasingly finding practices are up for the challenge.
Break out case study: The South Cheshire and Vale Royal GP Alliance
The South Cheshire and Vale Royal GP Alliance is an ambitious federation of 30 practices determined to harness the benefits of delivering primary care at scale. The alliance is developing innovative ways to enhance patient care and improve efficiency. Key to its plans is the ability to share information and resources across its practice network.
With some member practices already using digital dictation, the federation was keen to look at a system that would enable information sharing. Lexacom Connect allows the federation’s practices to create shared secretarial pools to transcribe dictations, ensuring adequate admin resource is available during workload peaks and staff shortages.
The federation is divided into six care communities, all of which are focusing on specific aspects of care to improve services for patients. One care community is already using our digital dictation system to support service delivery across its network. Some individual practices are also making use of Echo, our speech recognition software accessible via the same platform. As work progresses, the care communities are sharing best practice and supporting fellow care communities in implementing new ways of working.
One practice secretary at Ashfields Primary Care said: “With Lexacom, it’s very easy to see which dictations are urgent. We can also opt to sort dictations by size and author if we need to clear a backlog or complete one clinician’s dictations ahead of annual leave, for example.”
In addition to making full use of cloud-based digital dictation, one practice is about to trial our approved medical transcription service. In addition, the alliance is trialling remote working for secretarial staff, which will allow practices to offer more flexible working arrangements with appropriate governance in place.
The combination of remote working, shared secretarial pools, speech recognition and outsourced transcription gives the 30 practices a variety of options to consider as they work together to improve efficiency and patient care. By exploring the pooling of back office resources, the alliance aims to free up staff time which could be used to deliver the some of the ambitious changes set out in the Five Year Forward View.
“The future of general practice is working at scale in an efficient, lean, cost effective way that standardises and harmonises the delivery of care across a patch. Lexacom truly understands general practice and is the innovative and agile partner we need in these challenging times.” Dr Neil Paul – GP, GP Federation Board Member and Community Services Director.